Your Name
*
Your Title
Phone Number
*
Email Address
*
Main Point of Contact (POC)
Check here if you are the main POC.
Same
POC Name
*
POC Phone
*
POC Email Address
*
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Business Information
Business Legal Name
*
Business Legal Mailing Address
*
Street Address
Street Address Line 2
City
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Alabama
Alaska
Arizona
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California
Colorado
Connecticut
Delaware
District of Columbia
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Hawaii
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Indiana
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Maine
Maryland
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Michigan
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New York
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
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Washington
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State
Zip Code
Business Structure
*
Sole Proprietor / Entreprenuer / Freelancer
Partnership
LLC (Limited Liability Company)
Corporation (C-Corp / S-Corp)
Nonprofit Organization
Not yet formed
Business Size
*
Solo / Self-employed
2 - 10 employees
11-50 employees
51-200 employees
200+ employees
Age of Business
*
Not yet launched
Less than one year
1-3 years
4-7 years
8-15 years
15+ years
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Business Information (published)
Business Nickname or Acronym
How your customers might refer to your business.
Business Tagline
Business Website URL
*
If there is no website, type N/A.
Business Blog URL
Business Phone Number
Business Email Address
Is this a brick and mortar business? ( physical location)
*
Yes
No
Business Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Zip Code
Do you have more than one location?
*
Yes
No
How many?
*
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Market / Industry Information
Describe your business.
*
Basically, your elevator pitch.
What is your primary industry / niche?
*
Secondary industry / niche?
In order of importance, what are the top 1-3 buiness products and/or services?
Product / Service #1
*
Product / Service #2
Product / Service #3
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Describe your ideal customer or client (e.g., demographics, location, and key characteristics).
*
What are the top 3–5 qualities or strengths that differentiate you or your company from competitors?
*
What are your short-term business goals? (1 yr)
*
What are your long-term business goals? (3-5 yrs)
Describe any upcoming business opportunities?
What are your top 3 marketing challenges?
*
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Social Media
Do You Have Social Media Accounts for Your Business?
*
Yes
No
Who manages your social media?
*
How often do you engage with your followers and post on social media?
*
Inactive
1-3 times daily
1-2 times weekly
1-2 times per month
Facebook Business Profile URL
Instagram/Threads Business Profile URL
X (Twitter) Business Profile URL
TikTok Business Profile URL
LinkedIn Business Profile URL
YouTube Business Profile URL
Pinterest Business Profile URL
Snapchat Business Profile URL
Google My Business URL
Other
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Request For Services
What are your immediate marketing needs? (check all that apply)
Web Design (websites, landing pages, blog, ecommerce, communities)
Social Media (profiles, management, strategy, advertising, selling)
Email Marketing (campaigns, automation, lead gen, newsletters, etc.)
Content Marketing (create engaging content across various mediums)
Search Engine Marketing (paid ads to rank higher in search)
Search Engine Optimization (organic methods to rank higher in search)
Paid Advertising (search ads, social media ads, retargeting)
Conversion Rate Optimization (website audit, data analytics, strategy)
Brand Identity (logo, business cards, aesthetic, messaging, strategy)
Graphic Design (flyers, signage, banners, display ads, social media, etc.)
Marketing Consulting (strategy and coaching)
Other
What are your marketing expectations?
What is your estimated project budget?
*
Please Select
$1000-2500
$2500-5000
$5000-10000
$10000+
Preferred Project Completion Date?
*
/
Month
/
Day
Year
Date
How did you hear about Socially Active Media?
*
Referral
Social Media
Web Search
Online Ad
Blog Post
Sales Team
Event
Other
Referral Name (so we can say thanks!)
Anything else we should know.
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